Faulty Reporting on a Flawed Study on Home Birth

The New York Times, as well as dozens of other media outlets, is reporting this week that a new review of studies shows that infants born at home have a higher rate of death than infants born in the hospital.

This is a strange way to spin a review of studies that, according to the authors, actually shows that in every other index measured, women who give birth at home have equal or more positive outcomes than women who give birth in the hospital.

According to the study’s abstract, women who give birth at home: “are less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation.”

However, the study also concludes that the evidence reviewed shows that babies born at home are more likely to die between one week and one month of life than babies born in the hospital.

I have not read the original study, or all of the studies cited to come to this conclusion. But other more knowledgeable critics than I have found that this review of studies, authored by Joseph R. Wax, M.D., et al, ” Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis,” is seriously flawed.

According to the Midwives Alliance of North America (MANA) press release, Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia, who is an acknowledged expert on assessing the quality of literature related to home birth, finds the study deeply flawed: “[T]he authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.”

MANA’s press release continues, “This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.”

In her article, “Tripled Risk of Newborn Death at Home?,” the Midwife Next Door provides links to and quotes from the original studies cited in this review. Her conclusion: “This is a situation where the evidence simply does not add up to the conclusion. The preponderance of the evidence still falls in support of safety of planned home births with a certified/registered/licensed attendant.”

The Big Push for Midwives also argues the timing of the release of and the framing of the conclusions of this review of studies is politically motivated. “Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

“The conclusions don’t match the study,” agrees Augustine Colebrook, CPM, LM, who has been in private practice for seven years and has attended over 300 births. “Home birth is actually safer for the low-risk pregnancy baby and mother … before, during, and after labor.”

But the American College of Obstetrics and Gynecology (ACOG) actively opposes home birth. ACOG issued a statement in February 2008 condemning home birth. The anti-home birth resolution belittles home birth advocates by claiming they are painting a “rosy picture” of birth and, despite the fact that over a dozen large scale studies show that planned home birth is as safe or safer than hospital birth, ACOG cites “safety concerns” as the primary reason for their position against home birth.

The new study will be published in the American Journal of Obstetrics and Gynecology, a peer-reviewed obstetrics journal that has an advisory board, an editorial team, and a list of consultants made up in large part of ACOG members. Most doctors in America are no longer attending home births. They lose their patients and a significant income stream when women choose to give birth at home. That they have a bias against home birth is understandable, though unfortunate. That they skew the scientific evidence to support that bias is unpardonable.